16.1.4 Treatment of tuberculosis in children
As you read in Study Session 13, DOTS (Directly Observed Treatment, Short-course) should be used for all children with tuberculosis. Even when drugs are given under DOTS, tolerance of the medications must be closely monitored. Do not rely solely upon the parents of the child to supervise DOTS; you are responsible for monitoring.
Table 16.1 show different categories of TB cases that you are already familiar with, together with the drug treatment regimen required in children (the number of months for each treatment is indicated by the number in front of the bracket containing the drug combination).
Table 16.1 TB diagnostic category and the recommended treatment regimen in children.
|TB treatment category||TB cases||Regimen (daily or three times every week)|
|Intensive phase||Continuation phase|
|I||2 (HRZE)||4 (HR)|
|I||TB meningitis||2 (HRZS)||4 (HR)|
|II||Previously treated smear-positive pulmonary TB: relapse, treatment after interruption and treatment failure||2 (HRZES) followed by 1 (HRZE)||5 (HRE)|
|III||New smear-negative pulmonary TB (other than in category I). Less severe forms of extra-pulmonary TB||2 (HRZ)||4 (HR)|
|IV||Chronic and MDR-TB||Specially designed standardised or individualised regimens|
What are the differences in the drug treatment regimens for adults and children for each category? (Hint: compare Table 16.1 and Table 14.3).
In general, the treatment of TB in children is similar to that used to treat adults. However, there are some important differences; if you study Table 16.1 very closely, alongside Table 14.3 from Study Session 14, you will notice some differences. For children, the continuation phase in Categories I and III uses isoniazid and rifampicin in combination (HR), and during the intensive phase for Category III, a combination of three drugs is used (isoniazid, rifampicin and pyrazinamide (HRZ)). For cases of TB meningitis in children, streptomycin is used instead of the preferred drug for adults, ethambutal.